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Back to Basics: Validation of the Admission Systemic Inflammatory Response Syndrome Score in Predicting Outcome in Trauma

Malone, Debra L. MD; Kuhls, Deborah MD; Napolitano, Lena M. MD; McCarter, Robert ScD; Scalea, Thomas MD

The Journal of Trauma: Injury, Infection, and Critical Care: September 2001 - Volume 51 - Issue 3 - p 458-463
Annual Meeting Articles

Background We have previously documented that the admission systemic inflammatory response syndrome (SIRS) score, calculated with four variables—temperature, heart rate, neutrophil count, and respiratory rate—is a significant predictor of outcome in trauma (n = 4,887). The objective of this current study was to validate our previous findings in a larger trauma patient population, to analyze the predictive accuracy of the four individual components of the SIRS score (temperature, heart rate, neutrophil count, and respiratory rate), and to assess whether the admission SIRS score is an accurate predictor of intensive care unit (ICU) resource use in trauma.

Methods Prospective data were collected on 9,539 patients admitted to a Level I trauma center over a 30-month period (January 1997–July 1999). Patients were stratified by age, sex, race, and Injury Severity Score (ISS). SIRS score was calculated at admission, and SIRS was defined as a SIRS score ≥ 2.

Results SIRS score was validated as a significant independent predictor of outcome in trauma by logistic regression analysis after controlling for age and ISS. Of the four SIRS variables, hypothermia (temperature < 36°C) was the most significant predictor of mortality after controlling for age and ISS. Leukocytosis (neutrophil count > 12,000/mm3) was the most significant predictor of total hospital length of stay. SIRS scores of ≥ 2 were increasingly predictive of mortality and ICU admission by logistic regression analysis (p < 0.001).

Conclusion These data provide further validation that an admission SIRS score of ≥ 2 is a significant independent predictor of outcome and ICU resource use in trauma. Temperature (hypothermia) is the individual component of the SIRS score with the greatest predictive accuracy. SIRS score should be calculated on all trauma admissions.

From the Departments of Surgery (D.L.M., D.K., L.M.N., T.S.) and Epidemiology (R.M.), University of Maryland School of Medicine, and the R Adams Cowley Shock Trauma Center, Baltimore, Maryland.

Submitted for publication February 16, 2001.

Accepted for publication May 14, 2001.

Poster presentation at the 14th Annual Meeting of the Eastern Association for the Surgery of Trauma, January 10–13, 2001, Tarpon Springs, Florida.

Address for reprints: Lena M. Napolitano, MD, 10 North Greene Street, Room 5C-122, Baltimore, MD; email:

© 2001 Lippincott Williams & Wilkins, Inc.